Start of the exercise class

Once the exercise leader and exercise team have agreed on the exercise status of the group members and the class environment is ready, the group can enter the class. The exercise leader and team are responsible for the following;

• Meet and greet all patients and partners and welcome to group;

- pre-exercise heart rate and blood pressure; blood sugar level, if appropriate;

- clinical status and symptom check;

- medication issues and compliance; confirm advice on non-use of GTN spray at class without first advising and discussing with staff;

- check home activity and completion of exercise diary;

- discuss and review progress on CR goals, e.g. lifestyle and risk factor modification;

- ensure footwear and clothing suited to exercise; no recent alcohol or heavy meal prior to exercising; no chewing gum;

• Patient and CR professional jointly agree patient is fit for exercise session;

• Introduction to class:

- Welcome and introduce all patients, partners and visitors/observers;

- Remind participants of general house-keeping arrangements, e.g.

- timing and plan for exercise session; drinking water available

- safety issues; fire exits and evacuation procedures.

• Advise patients on importance of pacing of effort and using self-monitoring RPE, recognition of symptoms and responsibility to report any concerns to staff;

• Present induction to exercise programme and environment for new patients to session. A 'buddy' system can be used, where a new member is paired with an established CR participant who guides the new person round the exercise class. Alternatively, a member of support staff can work alongside the new person during session to help them integrate;

• Introduce or revise detail and order of stations in circuit (circuit display cards);

• Have member of staff with responsibility for supporting partners present.

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